Provider Demographics
NPI:1609856236
Name:HANSTAD, BRAD E (OD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:E
Last Name:HANSTAD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5044 TENNYSON PKWY
Mailing Address - Street 2:STE B
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2953
Mailing Address - Country:US
Mailing Address - Phone:972-378-4104
Mailing Address - Fax:972-378-9094
Practice Address - Street 1:5044 TENNYSON PKWY STE B
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2953
Practice Address - Country:US
Practice Address - Phone:972-378-4104
Practice Address - Fax:972-378-9094
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7943T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND800558OtherBLUE CROSS VISION
U63377Medicare UPIN
ND800558OtherBLUE CROSS VISION